Background
Methods
Population
Data collection
Outcomes
Persistent postpartum haemorrhage
Blood loss, bleeding rate and signs of haemorrhagic shock at time of inclusion
Statistical analysis
Results
Bleeding characteristic | Persistent postpartum haemorrhage (N = 1260) | Blood loss ≥1000 mL (N = 1391) | Blood loss ≥1500 mL (N = 1344) | Blood loss ≥2000 mL (N = 1252) | Blood loss ≥2500 mL (N = 1050) |
---|---|---|---|---|---|
Time from birth till inclusion of patients – no. (%) | |||||
< 1 h | 820 (65.1) | 819 (58.7) | 553 (41.1) | 309 (24.7) | 160 (15.2) |
≥ 1–2 h | 251 (19.9) | 318 (22.9) | 385 (28.6) | 419 (33.5) | 341 (32.5) |
≥ 2 h | 189 (15.0) | 257 (18.5) | 406 (30.2) | 524 (41.9) | 549 (52.3) |
Mode of birth - no. (%) | |||||
Vaginal | 967 (76.7) | 1032 (74.2) | 1002 (74.6) | 945 (75.5) | 792 (75.4) |
Caesarean | 285 (22.6) | 351 (25.2) | 3354 (24.9) | 301 (24.0) | 253 (24.1) |
Unknown | 8 (0.6) | 8 (0.6) | 7 (0.5) | 6 (0.5) | 5 (0.5) |
Cause of haemorrhage – no. (%) | |||||
Uterine atony | 805 (63.9) | 901 (64.8) | 874 (65.0) | 824 (65.8) | 685 (65.2) |
Retained placenta | 219 (17.4) | 231 (16.6) | 227 (16.9) | 207 (16.5) | 172 (16.4) |
Abnormally invasive placenta | 113 (9.0) | 113 (8.1) | 107 (8.0) | 100 (8.0) | 89 (8.5) |
Placenta previa | 12 (1.0) | 19 (1.4) | 19 (1.4) | 18 (1.4) | 17 (1.6) |
Placental abruption | 12 (1.0) | 28 (2.0) | 24 (1.8) | 18 (1.4) | 16 (1.5) |
Surgical cause | 92 (7.3) | 92 (6.6) | 87 (6.5) | 81 (6.5) | 69 (6.6) |
Pre-existent coagulation disorder | 7 (0.6) | 7 (0.5) | 6 (0.4) | 4 (0.3) | 2 (0.2) |
Bleeding rate – no. (%) | |||||
< 1 L/hr. | 457 (36.3) | 496 (35.7) | 508 (37.8) | 499 (39.9) | 432 (41.1) |
≥ 1-2 L/hr. | 316 (25.1) | 332 (23.9) | 315 (23.4) | 302 (24.1) | 266 (25.3) |
≥ 2 L/hr. | 481 (38.2) | 552 (39.7) | 513 (38.2) | 445 (35.5) | 349 (33.2) |
Unknown | 6 (0.5) | 11 (0.8) | 8 (0.6) | 6 (0.5) | 3 (0.3) |
Signs of haemorrhagic shock – no. (%) | |||||
No | 344 (27.3) | 416 (29.9) | 385 (28.6) | 295 (23.6) | 190 (18.1) |
Yes | 580 (46.0) | 488 (35.1) | 693 (51.6) | 811 (64.8) | 782 (74.5) |
Unknown | 336 (26.7) | 487 (35.0) | 266 (19.8) | 146 (11.7) | 78 (7.4) |
Packed red blood cells transfused – no. (%) | |||||
No | 1196 (94.9) | 1271 (91.4) | 1145 (85.2) | 888 (70.9) | 536 (51.0) |
Yes | 64 (5.1) | 120 (8.6) | 199 (14.8) | 364 (29.1) | 514 (49.0) |
Bleeding characteristic | Persistent postpartum haemorrhage (N = 1260) | ≥4 units RBC (N = 845) | ≥6 units RBC (N = 325) | ≥8 units RBC (N = 176) | ≥10 units RBC (N = 115) |
---|---|---|---|---|---|
Time from birth till inclusion of patients – no. (%) | |||||
< 1 h | 820 (65.1) | 37 (4.4) | 9 (2.8) | 4 (2.3) | 2 (1.7) |
≥ 1–2 h | 251 (19.9) | 96 (11.4) | 41 (12.6) | 11 (6.3) | 3 (2.6) |
≥ 2 h | 189 (15.0) | 712 (84.3) | 275 (84.6) | 161 (91.5) | 110 (95.7) |
Unknown | – | – | – | 1 (0.5) | – |
Mode of birth - no. (%) | |||||
Vaginal | 967 (76.7) | 612 (72.4) | 207 (63.7) | 100 (56.8) | 62 (53.9) |
Caesarean | 285 (22.6) | 228 (27.0) | 116 (35.7) | 75 (42.6) | 53 (46.1) |
Unknown | 8 (0.6) | 5 (0.6) | 2 (0.6) | 1 (0.6) | – |
Cause of haemorrhage – no. (%) | |||||
Uterine atony | 805 (63.9) | 539 (63.8) | 214 (65.8) | 107 (60.8) | 66 (57.4) |
Retained placenta | 219 (17.4) | 135 (16.0) | 29 (8.9) | 18 (10.2) | 13 (11.3) |
Abnormally invasive placenta | 113 (9.0) | 71 (8.4) | 26 (8.0) | 17 (9.7) | 13 (11.3) |
Placenta previa | 12 (1.0) | 13 (1.5) | 6 (1.8) | 4 (2.3) | 3 (2.6) |
Placental abruption | 12 (1.0) | 18 (2.1) | 11 (3.4) | 5 (2.8) | 1 (0.9) |
Surgical cause | 92 (7.3) | 66 (7.8) | 36 (11.1) | 22 (12.5) | 16 (13.9) |
Pre-existent coagulation disorder | 7 (0.6) | 3 (0.4) | 3 (0.9) | 3 (1.7) | 3 (2.6) |
Blood loss – no. (%) | |||||
< 1 L | 673 (53.4) | 7 (0.8) | 1 (0.3) | 1 (0.6) | – |
≥ 1-2 L | 407 (32.3) | 82 (9.7) | 15 (4.6) | 3 (1.7) | 2 (1.7) |
≥ 2 L | 180 (14.3) | 756 (89.5) | 309 (95.1) | 172 (97.7) | 113 (98.3) |
Bleeding rate – no. (%) | |||||
< 1 L/hr. | 457 (36.3) | 689 (81.5) | 24 (74.2) | 127 (72.2) | 80 (69.6) |
≥ 1-2 L/hr. | 316 (25.1) | 100 (11.8) | 56 (17.2) | 34 (19.3) | 21 (18.3) |
≥ 2 L/hr. | 481 (38.2) | 41 (4.9) | 23 (7.1) | 12 (6.8) | 12 (10.4) |
Unknown | 6 (0.5) | 15 (1.8) | 5 (1.5) | 3 (1.7) | 2 (1.7) |
Signs of haemorrhagic shock – no. (%) | |||||
No | 344 (27.3) | 85 (10.1) | 23 (7.1) | 9 (5.1) | 6 (5.2) |
Yes | 580 (46.0) | 722 (85.4) | 288 (88.6) | 159 (90.3) | 104 (90.4) |
Unknown | 336 (26.7) | 38 (4.5) | 14 (4.3) | 8 (4.5) | 5 (4.3) |
Definition based on | Maternal death | Hysterectomy | Arterial embolisation | Admission on intensive care unit | Composite adverse maternal outcome |
---|---|---|---|---|---|
Number of patients (%) | |||||
Persistent postpartum haemorrhage (N = 1260) | 7 (0.6) | 64 (5.1) | 165 (13.1) | 362 (28.7) | 430 (34.1) |
Estimated blood loss | |||||
≥ 1000 mL (N = 1391) | 7 (0.5) | 73 (5.2) | 173 (12.4) | 399 (28.7) | 471 (33.9) |
≥ 1500 mL (N = 1344) | 7 (0.5) | 73 (5.4) | 171 (12.7) | 388 (28.9) | 459 (34.2) |
≥ 2000 mL (N = 1252) | 6 (0.5) | 73 (5.8) | 171 (13.7) | 372 (29.7) | 443 (35.4) |
≥ 2500 mL (N = 1050) | 6 (0.6) | 71 (6.8) | 168 (16.0) | 348 (33.1) | 417 (39.7) |
Transfusion of packed red blood cells | |||||
≥ 4 units (N = 845) | 7 (0.8) | 68 (8.0) | 159 (18.8) | 321 (38.0) | 383 (45.3) |
≥ 6 units (N = 325) | 5 (1.5) | 62 (19.1) | 125 (38.5) | 215 (66.2) | 258 (79.4) |
≥ 8 units (N = 176) | 4 (2.3) | 54 (30.7) | 84 (47.7) | 146 (83.0) | 165 (93.8) |
≥ 10 units (N = 115) | 3 (2.6) | 44 (38.3) | 64 (55.7) | 101 (87.8) | 113 (98.3) |
Definition based on | Total blood loss (L) | Time from birth till end of bleeding (hours) | Total units of transfused RBCs | Time from birth till transfusion of first RBC-unit (hours) |
---|---|---|---|---|
Median (interquartile range) | ||||
Persistent postpartum haemorrhage (N = 1260) | 3.0 (2.5–4.0) | 3.4 (2.1–5.9) | 4 (3–6) | 2.5 (1.6–4.2) |
Estimated blood loss | ||||
≥ 1000 mL (N = 1391) | 3.0 (2.5–4.0) | 3.3 (2.0–5.8) | 4 (3–6) | 2.5 (1.5–4.2) |
≥ 1500 mL (N = 1344) | 3.0 (2.5–4.0) | 3.3 (2.0–5.8) | 4 (3–6) | 2.5 (1.5–4.2) |
≥ 2000 mL (N = 1252) | 3.0 (2.5–4.0) | 3.4 (2.1–5.9) | 4 (3–6) | 2.4 (1.5–4.1) |
≥ 2500 mL (N = 1050) | 3.5 (3.0–4.2) | 3.6 (2.1–6.1) | 4 (3–6) | 2.3 (1.5–3.8) |
Transfusion of packed red blood cells | ||||
≥ 4 units (N = 845) | 3.5 (2.7–4.5) | 3.8 (2.2–6.4) | 5 (4–7) | 2.3 (1.4–3.7) |
≥ 6 units (N = 325) | 4.8 (3.6–6.5) | 6.5 (3.1–8.6) | 8 (6–12) | 2.0 (1.0–3.3) |
≥ 8 units (N = 176) | 6.0 (4.5–8.0) | 6.1 (4.1–12.0) | 11 (9–15) | 1.9 (0.8–3.3) |
≥ 10 units (N = 115) | 7.0 (5.1–9.8) | 6.9 (4.4–12.8) | 13 (11–18) | 1.8 (0.7–3.0) |